Healthcare Provider Details

I. General information

NPI: 1649938259
Provider Name (Legal Business Name): KEVIN STEVEN LOPEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S MARYLAND PKWY STE 608
LAS VEGAS NV
89109-2428
US

IV. Provider business mailing address

3201 S MARYLAND PKWY STE 608
LAS VEGAS NV
89109-2428
US

V. Phone/Fax

Practice location:
  • Phone: 702-457-5437
  • Fax: 702-464-5801
Mailing address:
  • Phone: 702-457-5437
  • Fax: 702-464-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2569
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: